You are here

The Priory Hospital North London Good

All reports

Inspection report

Date of Inspection: 21 October 2010
Date of Publication: 21 December 2010
Inspection Report published 21 December 2010 PDF

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care (outcome 16)

Not met this standard

We checked that people who use this service

  • Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety.

How this check was done

Our judgement

A number of audits had been carried out to assess and monitor the care and treatment provided to patients and their safety and there was some recent evidence of learning from incidents. There was evidence that actions were taken to address risks but these were not always followed up to ensure that improvements had been made. The system for gathering feedback from users of services was ineffective and very little information on the experiences of patients was gathered. Without effective monitoring of the quality of care, including patients’ perspectives, there is a risk that they will receive inadequate and unsafe care and treatment.

User experience

No comments on this outcome were received.

Other evidence

The hospital has systems in place for gathering information and evaluating the quality of care and treatment provided to patients. We were told by a Senior Manager that Clinical Governance meetings take place every month and that the findings of clinical audits are discussed. We looked at four sets of minutes from Clinical Governance Committee meetings held in February, August (two meetings held) and September 2010. All of these provided evidence of a range of audits being conducted including audits of therapy sessions, care planning, clinical documentation and suicide prevention. We also saw a report of an annual waste management and disposal audit that took place on 20/05/10 and an audit of patients detained under a section of the Mental Health Act between 19/05/10 and 18/06/10.

There was evidence of risk assessment in the form of a regular environmental risk assessment and an audit of ligature points in the hospital carried out in October 2010. We saw a copy of a suicide prevention audit carried out on the adult ward on 23/10/10. The audit reviewed the contents of ten patient clinical files. Each patient had a risk assessment completed on admission. For three of the ten patients there was an identified suicide risk and for these three a risk assessment had been completed and documented before any change in observation level made and the observation level was clearly identified. Of the seven patients not identified as a suicide risk, assessments of risk were being identified at regular intervals. An action plan was attached to the audit stating that the Ward Manager was responsible for weekly monitoring. We saw a hospital accident statistics record for 2010. This showed the number of accidents and incidents recorded and graded according to severity.

A senior manager told us that satisfaction surveys are sent out to patients after discharge by an external company and a quarterly report is shared at team meetings. We did not see evidence of a patient satisfaction survey report and the Clinical Governance Committee meetings noted on 27/08/10 that the survey was ‘still ongoing but very poor’ and stated that on discharge patients are given a card requesting them to provide their email addresses to be forwarded to the external company so that they could receive the questionnaire. Returns, however, had been poor and ‘in a period of 3 months, 6 patients responded to this request’. The minutes for the meeting on 24/09/10 stated ‘no feedback’ in relation to the patient survey and that it was ‘not successful and not working’. Staff on the adult ward told us that there had been no patient surveys in the last year. Therefore the provider is receiving very little in terms of feedback from people who use services. One staff member told us that the patients forum was to be restarted in October, ‘the first this year’.

There was some evidence that learning had taken place and changes made in response to adverse events and incidents. Minutes of the hospital Clinical Governance Committee meeting on 24/09/10 noted that there had been ten recorded incidents on the adolescent ward since the previous meeting and linked these incidents to boredom in the evenings and a lack of structure in the day time activity programme for the young people. It was agreed at this meeting that a full review of the programme would be carried out to identify where additional therapeutic resources were needed. It was also stated that additional staffing would be provided on the ward between 5pm – 9pm to assist with activities. During our visit to the adolescent ward three young people told us about the new activities programme on the ward which they said was a big improvement.

Generally, however, there was little evidence that where risks had been identified and action plans put in place that these were followed up effectively to ensure that improvements were made.